内容紹介
Summary
We report a case of asynchronous bilateral neuroendocrine breast carcinoma. The patient was a 49-year-old woman presenting with a bloody nipple discharge from the right breast. We suspected intraductal papilloma and performed a microdochectomy. A pathological analysis of the resected specimen confirmed the diagnosis as neuroendocrine carcinoma. The tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, and synaptophysin, but negative for the HER2/neu marker. The Ki-67 labeling-index was 40%. As the tumor margin was positive, breast-conserving surgery plus levelⅡ axillary lymph node dissection was performed. After surgery, radiotherapy(total dose of 50 Gy)was administered for treating residual breast involvement. Adjuvant hormonal therapy was performed for 5 years. Ten years after surgery, ultrasonography revealed a 12 mm irregular hypoechoic mass in the left breast. The mass was diagnosed as a solid tubular carcinoma based on core needle biopsy findings. Subsequently, we performed breast-conserving surgery. The pathological diagnosis was a neuroendocrine carcinoma, and the tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, synaptophysin, and CD56, but negative for the HER2/neu marker. The Ki-67 labeling-index was 50%. We report our experiences with a rare case of asynchronous bilateral neuroendocrine breast carcinoma. In this case, ultrasonography was a useful modality for detecting both the lesions.
要旨
片側が神経内分泌癌であった異時性両側性乳癌を経験した。症例は49歳,女性。右乳頭血性異常分泌を主訴に来院した。右乳管内乳頭腫の疑いで右側の乳管腺葉区域切除術を施行したところneuroendocrine carcinomaの診断であった。切除断端が陽性であったため乳房円状部分切除術+levelⅠリンパ節郭清術を施行しT1N0M0=StageⅠと診断された。残存乳腺に対する放射線治療50 Gy施行後,2年間のLH-RH agonistおよび5年間tamoxifenを投与していた。手術から10年目の超音波検査で,左乳房C領域に直径12 mm,辺縁不整な低エコー腫瘤を認めた。針生検で浸潤性乳管癌と診断された。乳房円状部分切除術+センチネルリンパ節生検術を施行した。病理組織診断は浸潤性乳管癌(neuroendocrine carcinoma),ER陽性,PgR陽性,HER2陰性,Ki-67 50%,synaptophysin陽性,chromogranin A陽性,CD56陽性,n(-),切除断端陰性,T1N0M0=StageⅠと診断された。
目次
We report a case of asynchronous bilateral neuroendocrine breast carcinoma. The patient was a 49-year-old woman presenting with a bloody nipple discharge from the right breast. We suspected intraductal papilloma and performed a microdochectomy. A pathological analysis of the resected specimen confirmed the diagnosis as neuroendocrine carcinoma. The tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, and synaptophysin, but negative for the HER2/neu marker. The Ki-67 labeling-index was 40%. As the tumor margin was positive, breast-conserving surgery plus levelⅡ axillary lymph node dissection was performed. After surgery, radiotherapy(total dose of 50 Gy)was administered for treating residual breast involvement. Adjuvant hormonal therapy was performed for 5 years. Ten years after surgery, ultrasonography revealed a 12 mm irregular hypoechoic mass in the left breast. The mass was diagnosed as a solid tubular carcinoma based on core needle biopsy findings. Subsequently, we performed breast-conserving surgery. The pathological diagnosis was a neuroendocrine carcinoma, and the tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, synaptophysin, and CD56, but negative for the HER2/neu marker. The Ki-67 labeling-index was 50%. We report our experiences with a rare case of asynchronous bilateral neuroendocrine breast carcinoma. In this case, ultrasonography was a useful modality for detecting both the lesions.
要旨
片側が神経内分泌癌であった異時性両側性乳癌を経験した。症例は49歳,女性。右乳頭血性異常分泌を主訴に来院した。右乳管内乳頭腫の疑いで右側の乳管腺葉区域切除術を施行したところneuroendocrine carcinomaの診断であった。切除断端が陽性であったため乳房円状部分切除術+levelⅠリンパ節郭清術を施行しT1N0M0=StageⅠと診断された。残存乳腺に対する放射線治療50 Gy施行後,2年間のLH-RH agonistおよび5年間tamoxifenを投与していた。手術から10年目の超音波検査で,左乳房C領域に直径12 mm,辺縁不整な低エコー腫瘤を認めた。針生検で浸潤性乳管癌と診断された。乳房円状部分切除術+センチネルリンパ節生検術を施行した。病理組織診断は浸潤性乳管癌(neuroendocrine carcinoma),ER陽性,PgR陽性,HER2陰性,Ki-67 50%,synaptophysin陽性,chromogranin A陽性,CD56陽性,n(-),切除断端陰性,T1N0M0=StageⅠと診断された。